Painkillers in pregnancy: paracetamol, ibuprofen and codeine

Paracetamol is usually the painkiller to reach for in pregnancy. Others, including ibuprofen, aspirin and codeine, are best avoided unless a doctor prescribes them. Here’s why, and what to do if you’ve already taken something.

Paracetamol: usually the first choice

The NHS says paracetamol is usually the best painkiller in pregnancy, and bumps calls it the best studied. It can be used at any stage for pain or a high temperature.

Take the lowest dose that works, for the shortest time you need it.
Stick to the dose on the packet, and ask a pharmacist if you’re unsure.
If your pain doesn’t go away, get advice rather than taking more.

Treating pain and fever matters. The MHRA, the UK medicines regulator, says untreated pain and fever can carry risks for the baby.

What about the headlines on paracetamol and autism?

In September 2025 the MHRA said there is no evidence that paracetamol in pregnancy causes autism, and that it remains the recommended painkiller. In January 2026 it responded to a new review of the research, which found no link with autism, ADHD or intellectual disability. Bumps says the highest quality studies don’t show that paracetamol causes autism or affects other parts of a child’s development.

Ibuprofen and other anti-inflammatory painkillers

Ibuprofen is an NSAID (non-steroidal anti-inflammatory drug). The NHS says to avoid it in pregnancy unless a doctor or pharmacist advises you to take it. Bumps says it shouldn’t be used unless a doctor prescribes it, especially from 20 weeks.

From 20 weeks, bumps explains, ibuprofen can reduce the fluid around the baby, which can affect how the lungs and kidneys develop. It can also cause an important blood vessel in the baby’s circulation, which needs to stay open in the womb, to close too early. Stopping ibuprofen often lets these effects settle.

Other NSAIDs include naproxen, mefenamic acid and diclofenac (including the gel and patches). The NHS says NSAIDs aren’t usually recommended in pregnancy.

If you took ibuprofen before you knew

Try not to worry. Bumps says ibuprofen taken before 20 weeks is unlikely to harm the baby, and you wouldn’t normally need any extra scans. Use paracetamol instead from now on, unless a doctor has prescribed ibuprofen.

If you took it after 20 weeks

Stop taking it, and tell your midwife or doctor as soon as you can, especially if you took several doses. They may offer a scan to check your baby and the fluid levels.

Aspirin: low dose and pain relief are different

Low-dose aspirin (75mg to 150mg a day) may be prescribed by your midwife or doctor if you’re at higher risk of pre-eclampsia. It’s taken daily from 12 weeks until your baby is born. Don’t start it unless your midwife or GP advises it.
Aspirin for pain (usually 300mg tablets) isn’t recommended at any stage of pregnancy. Bumps says taking it before 20 weeks is unlikely to harm the baby. If you’ve taken it for pain after 20 weeks, stop and contact your midwife or doctor as soon as you can.

Some cold and flu remedies contain aspirin, so check the label or ask a pharmacist.

Codeine

Codeine is sold on prescription and in some pharmacy painkillers, often combined with another painkiller. The NHS advises avoiding painkillers that contain codeine in pregnancy unless your doctor prescribes them.

Most studies don’t show that codeine harms the baby. Some suggest a slightly higher chance of a heart defect after use in early pregnancy, but it’s not clear codeine is the cause, and bumps says more research is needed. It also says no extra scans are needed beyond the routine 20-week scan.

Near birth: taking codeine in the run-up to birth can affect your baby once they’re born. Bumps says the baby may have withdrawal symptoms, such as being unusually irritable or shaky, and may have feeding problems or need some help with breathing. This usually eases in the first few days. Babies exposed to codeine shortly before birth are watched more closely for a while afterwards.

If codeine is prescribed for you, don’t stop without talking to your doctor.

Migraine medicines

Ask your GP before taking a migraine medicine in pregnancy. The NHS says sumatriptan can be used if needed. It’s the best studied triptan, and bumps says it isn’t known to pose any risk to the baby. There’s less information on the others, though no concerns that they cause harm. If your migraines are severe and a triptan helps, your doctor may suggest staying on it. Migraines often get better from the second trimester.

When the pain itself needs checking

In early pregnancy, contact your maternity unit or an early pregnancy unit straight away, or NHS 111 if you can’t reach them, if you have:

any bleeding
tummy pain that’s severe, on one side, or not easing after resting for 30 to 60 minutes
pain in the tip of your shoulder

If you haven’t seen a midwife yet, call NHS 111 or your GP surgery.

Call 999 if bleeding is heavy (soaking a pad soon after putting it on), or comes with severe tummy or shoulder pain, or with feeling sick, faint or dizzy. Also call 999 for sudden, severe tummy pain with feeling faint or dizzy, even without bleeding.

Later in pregnancy, usually from 20 weeks, a headache can be a sign of pre-eclampsia. Contact your maternity unit straight away, or NHS 111 if you can’t reach them, if you have a severe headache that doesn’t go away with simple painkillers, problems with your vision such as blurring or flashing lights, pain below your ribs, vomiting, or sudden swelling of your face, hands or feet.

Questions people ask

Can I take paracetamol in the first trimester?

Yes. Paracetamol can be used throughout pregnancy, at the lowest dose that works for the shortest time.

Can I take ibuprofen for a headache when pregnant?

It’s best not to unless a doctor advises it. Try paracetamol, rest and plenty of fluids. See headaches in pregnancy for more ideas.

Is it safe to take painkillers with codeine in pregnancy?

Only if a doctor recommends it. If you’ve taken a codeine painkiller from the pharmacy, mention it to your midwife or GP.